Pelvic girdle pain can be debilitating throughout pregnancy and the postpartum period. Common symptoms could include pain or discomfort with single-leg movements, as simple as just walking, and with pivoting movements, such as rolling in bed or getting out of your car. It is important to note that pelvic girdle pain does not need to be suffered just because you are pregnant! Common advice may include: the only solution is giving birth. This is not helpful, and more importantly, not accurate. You do not need to wait until birth to find relief from pelvic girdle pain. Let’s explore what could be causing pelvic girdle pain, and what we have found to be potential solutions!
What causes pelvic girdle pain? And what causes SI Joint Dysfunction (SJD)?
1. Pelvic Positioning
When we move, the pelvis and surrounding musculature work together to stabilize the pelvic joints (sacroiliac (SI) joints, and the pubic symphysis. Bony structures form closure on the joints to keep them from moving too much; the muscles and tissues force closure on the joints to keep them from moving too much, and then we have our neuromuscular connection that is coordinating the action of all these players.
When we move our body, the pelvic bones respond to this movement by shifting their position to better transfer force from the upper to the lower body, and vice versa.
When you are walking, when you put weight into one leg and begin to move your body forward, that half of the pelvis shifts posteriorly (backward), adducts (moves towards the midline), and internally rotates (the pelvis moves onto the fixed femur).
As the other leg swings forward in your stride, that half of the pelvis shifts anteriorly (moves forward), abducts (moves away from the midline), and externally rotates (the pelvis moves on the fixed femur). Then this alternates from side to side. This torque is the pelvic position that helps to force closure on the pelvic joints, to aid in stability.
If the pelvis does not shift in position or is stuck in a certain position (sometimes emphasizing external rotation or favoring one leg more so than the other), then the pelvic bones and surrounding musculature may not be able to force closure on the pelvic joints = decreases stability = increased movement = pain or discomfort.
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2. Relaxin
Relaxin is a hormone that increases joint laxity, however, higher relaxin levels are not necessarily associated with increased occurrence of pelvic girdle pain. Increased laxity in the joints does not automatically equal increased pain. This is important to understand that increased joint laxity is not an automatic reason for discomfort throughout your pregnancy. Rather, biomechanically, how you alter your motor control, postural tendency, and altered movement and stabilization patterns may contribute more so to pelvic girdle pain.
There is an increase in movement of the joints due to relaxin, but if the surrounding musculature is coordinated and strong enough to counter this increased laxity, you should find relief from pelvic girdle pain.
3. Activity Levels
Something that I discovered for myself during my pregnancies, and a trend with my own clients, is that inactivity seemed to increase pelvic girdle pain. Whenever I had SJD during my last pregnancy, it was usually linked to a period of time that I didn’t work out and was fairly inactive. Once I resumed my workout routine (particularly the strength training and pelvic stability programming), I found relief from my SJD pain.
In periods of inactivity, we may find that muscles become deconditioned and less ready to perform to stabilize the pelvis. Different muscles also experience different timeframes of atrophy. The multifidus, for example, experiences atrophy faster than surrounding musculature. The multifidus is a part of our deep core stabilization system, helping to stabilize the spine vertebrae to vertebrae. When it is not functioning as well as the rest of the system, we can see compensation patterns, and sometimes increased lower back pain.
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What are some solutions and approaches to managing SJD?
1. Pelvic Positioning
First, we can focus on the set up of the pelvis so that the structure can better force closure on the pelvic joints. This force closure helps to stabilize the pelvis, decreasing excessive movement at the joints, and will likely increase comfort.
Many of us favor a right stance posture, where the right leg is more internally rotated under the pelvis and the left leg is more externally rotated.
This stance shifts the tailbone towards the left side, and can cause increased tension in the left posterior pelvic floor. This shift in tension is supposed to happen as we walk and move, but if we always favor this stance we may find a muscular imbalance and it could affect the positioning of the pelvis and function of the surrounding musculature.
How can we find a better pelvic position? Usually by shifting the left hip crease back and finding more internal rotation on the left side. This will likely bring you into a more neutral pelvic position.
Another tool to help with pelvic position is to add adduction, or squeezing between the thighs. You can either squeeze a ball between the thighs or use a band to resistant against during your movement.
Watch the video below to learn how to do this.
2. Strengthening: The Posterior Oblique Sling
Now that the pelvis is in a better position, we can strengthen the surrounding musculature to continue to aid in force closure.
The posterior oblique sling helps to stabilize the SI joint. It runs from the lat to opposite glute. We can strengthen this sling by having co-activation or contraction of the opposite ends of the sling. So, we want to activate the lat with a rowing or pulling motion at the same time as we activists the glutes with hip extension.
We incorporate posterior oblique sling exercises in all of our fitness programs, both prenatal and postnatal, because it is so important that our backside is stronger for this and all phases of life.
If you find single leg movements are difficult or painful, we can modify movements to find your level of needed support.
Watch this video to learn more about the posterior oblique sling and exercises that could support pelvic stability of the SI joints.
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3. Mobility or Release Techniques
Release techniques could be helpful at any step, as a restriction could be pulling the pelvis into a less optimal position.
There is a lot we can focus on, but some of my favorites is to focus on releasing the posterior pelvic floor by emphasizing internal rotation and doing hip airplanes, which brings you into both internal and external rotation.
Watch the video below to follow along with a SI joint release mobility routine.
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Our 40-Week Prenatal Strength & Conditioning Program & 3-Week Pelvic Stability Accessory Program incorporate myofascial sling exercises meant to support pelvic stability throughout pregnancy. You can stay comfortable and move with ease throughout pregnancy.
References:
Wuytack, F., Begley, C., & Daly, D. (2020). Risk factors for pregnancy-related pelvic girdle pain: a scoping review. BMC pregnancy and childbirth, 20(1), 1-14.